Baby Formula to irrigate bladder????

Jolie, BSN · Jun 18, 2005

Ok, I have only been a nurse for a year and I know I don't know everything. Last night we did a C/S and the doctor told me he wanted me to irrigate the bladder through the foley with baby formula. I seriously thought he was joking. Apparently he thought he may have nicked the bladder.
I know the baby formula is suppose to be sterile or whatever. That just seems super strange to me. Does anyone else do this???

Have to say I've never heard of this. If he wanted to check for "leakage" from the bladder, isn't there some kind of sterile dye that could have been added to NS or sterile water? If formula was used and there was leakage, the patient would have sugary and fatty formula in her pelvic cavity. Sounds like a set-up for infection.

How is the lady doing?

NurseforPreggers · Jun 18, 2005

She's doing fine, thankfully he had not nicked the bladder so no formula spilled into her abdominal cavity. Thats kinda along the lines of what I was thinking too. I was thinking also about if she had any bacteria in her bladder that the formula would probably make a great breeding ground. I felt so weird about it that after I got to the recovery room I irrigated the bladder again with NS, even though I didn't have orders to do so.

allnurses Guide · Jun 18, 2005

Wow, never heard of it . . .have to ask the doc when he wakes up.

I would have the same concerns regarding infection . . all that milk sugar.

steph

NurseforPreggers · Jun 18, 2005

I just asked my mom who was a labor nurse for 23 years at a different hospital than I work at. She said she has done it too and that it won't hurt anything. Still really weird to me. The doctor must have thought I was an idiot because I just stood there and stared at him with a blank look on my face. Finally he said, have you ever done that? When I said no, he said ... get me someone who has.

mandykal, ADN, RN · Jun 18, 2005

I never heard of this before. As for Jolie, I wonder because he didn't use a dye or something, maybe he thought of a reaction to dye, esp in an infant.

But what questions me is what if there was a leak, and the formula entered the cavity? doesn't that happen with G-tube pts?

I remember an experience with a pt and the g-tube site was oozing with blk, grn drainage.....Results: the tube was not in place, infection set in...pts was a compromised elderly...then she was septic and died.

KAL

kids · Jun 18, 2005

I'm kind of surprised that formula was introduced into the bladder "on purpose".

Several years ago it was fairly common practice to use a foley catheter as a gastronomy tube. This fell out of favor after several deaths due to infection because of tube feedings being accidently connected to urinary catheters.

stevierae · Jun 18, 2005

I've not heard of this, either. Normally, in surgery, we give indigo carmine or methylene blue IV (anesthesia gives it) if there is any question at all about possibly nicking a ureter or the bladder. Normally, the patient has a Foley, and soon the urine comes out in the Foley colored from the dye--indicating that all is well.

If all wasn't well, the urine output would be decreased, (or absent) and the dye wouldn't be excreted in whatever urine was put out--and if the hole was in the bladder, the dye (and whatever urine was still present) would be extravasated into the pelvis . Then we'd be giving some Z-ray contrast IV (probbly Hypaque or renografin) calling X-ray for a KUB and retrograde cystogram to look for extravasation, and possibly doing a cystoscopy and calling in a urologist for consult, and, if need be, to scrub in and explore, repair said ureter, possibly insert a ureteral catheter, and, if the bladder was nicked, oversewing that nick. We sure wouldn't be leaving the room before we were absolutely certain that things were restored to normal. All those interventions would be charted in the nursing notes and in the surgeon's post-op report.

I can't imagine a patient being closed up, going through PACU, and then going to the floor with a surgeon still uncertain as to whether he had "nicked" the bladder---that problem should have been caught and corrected before the patient was closed.

I can't imagine why, if he thought he nicked the bladder, he didn't ask the anesthesia provider to give some IV indigo carmine or methylene blue during the C-section, since the patient already had both IV access and a Foley--easy enough to do.

suzanne4, RN · Jun 18, 2005

Using baby formula like that has been around for a very long time. They used to use "Enfamil" in the little bottles. Dyes were not always readily available and the formula was always around where they were doing sections...........

Told you that I have been a nurse for a very long time.........

And never saw any problems when it was used. Used primarily by OB/Gyn doctors in "female" surgeries.

SmilingBluEyes · Jun 18, 2005

wow in all our GYN surgical cases, I can't say I have ever heard of this. Intriguing. Learn something new every day.

amber1142 · Jun 18, 2005

This situation does bring up a really interesting dilemma. What should a nurse do when the doctor orders a treatment she has never heard of and which sounds very odd? We are even tested in NCLEX on which orders we should question, but how does it work in the real world.

After I read about the baby formula here, I looked it up on the Internet and found that it is indeed used, but when you're standing at the patient's bedside and the doc orders something, you don't have time to do a little research. What do you do? Carry out the order and pray that you don't lose your license if it turns out to be something completely off the wall?

What would you do if the doctor ordered something you had never heard of?

SmilingBluEyes · Jun 18, 2005

This situation does bring up a really interesting dilemma. What should a nurse do when the doctor orders a treatment she has never heard of and which sounds very odd? We are even tested in NCLEX on which orders we should question, but how does it work in the real world.
After I read about the baby formula here, I looked it up on the Internet and found that it is indeed used, but when you're standing at the patient's bedside and the doc orders something, you don't have time to do a little research. What do you do? Carry out the order and pray that you don't lose your license if it turns out to be something completely off the wall?
What would you do if the doctor ordered something you had never heard of?

I would question it politely and also discuss it with my charge nurse/supervisor---- and if it seems truly imprudent or dangerous, would contact the Chief of OB to address the issue. I would not participate in anything I knew to be dangerous or risky to the patient, and if I had doubts, I would definately "go up the chain" for advice. I readily admit, I do not know everything when it comes to OB at all. I am learning new things everyday and practices vary greatly by city, state and region!